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Social Determinants of Health Equity and Levels of Potential Impact in the System:
Opportunities for Leverage
Karen J. Minyard, Ph.D.Executive Director
Georgia Health Policy CenterGeorgia State University
Georgia Health Policy CenterA Research Center at Georgia State University
• Provides evidence-based research, program development, and policy guidance locally, statewide, and nationally
• Focuses on solutions to the most complex issues facing health care today including: insurance coverage, children’s health,
health care reform, and the development of urban and rural health systems
• Works in more than 200 communities across the U.S.
Health
How Healthy Are Georgians?Health Status by County
Georgia’s Health Ranking Among States: 2010
5
DETERMINANTS - Personal Behaviors2010Rank
2008 Rank
2007Rank
2003 Rank
Prevalence of Obesity (Percent of population) 28 40 38 36
DETERMINANTS - Community and Environment
High School Graduation (Percent of incoming 9th graders) 45 48 48 49
Infectious Disease (Cases per 100,000 population) 47 47 46 46Children in Poverty (Percent of persons under age 18) 40 41 40 37Air Pollution (Micrograms of fine particles per cubic meter) 46 50 50 47
DETERMINANTS - Public and Health PoliciesLack of Health Insurance (Percent without health insurance) 44 41 40 37
HEALTH OUTCOMESInfant Mortality (Deaths per 1,000 live births) 41 40 43 43Cardiovascular Deaths (Deaths per 100,000 population) 40 40 41 -
Factors Influencing Health Status
Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228
Social Determinants of Health Equity
Health Disparities
The unequal burden in disease morbidity and mortality rates
experienced by ethnic/racial groups as compared to the dominant group.
Source: Healthy People 2010, US HHS, 2000
Social Determinants of Health
The conditions in which people are born, grow, live, work and age,
including the health system. These circumstances are shaped by
the distribution of money, power and resources at global, national and local levels, which are themselves influenced
by policy choices.
Source: World Health Organization, 2008
Community-Level Determinants of Health Equity
Social Environment
Physical Environment
Economic Environment
Service Environment
Social Cohesion & Trust
Housing & Neighborhood Conditions
Employment Health & Human Services
Collective Efficacy Transportation Home Ownership Public Safety & Emergency Services
Civic Engagement HEAL Promoting Structures
Local Business Development
Education
Cultural Characteristics & Norms
Natural Resource Quality
Product Availability
Community-based Organizations
Aesthetics Cultural/Artistic Opportunities
Source: Grantmakers in Health, 2009; Institute of Medicine, 2008; PolicyLink, 2002; Prevention Institute, 2003
Health Equity Best Practices
CDC’s The Community Guide:– Community Preventive Services Task Force– Identified 200 community-based interventions in six areas– Reviews in three areas complete• Early childhood development = effective• Affordable and safe housing = effective• Access to culturally competent healthcare systems = insufficient
evidence
Evidence-based interventions:– Housing Mobility Policies– Early Childhood Development
Source: Anderson et al., 2003; CDC, 2009; Williams et al., 2008
Nurse-Family Partnership • Nurse home visit program for low-income, first-time parents• Significant outcomes:
– Reduced risks for antisocial behaviors for children– Reduced childhood injury– Reduced child abuse, maternal crime & substance abuse– Improved prenatal outcomes– Increased school readiness for children– Increased maternal employment & father involvement
• ROI=$5 for every $1 spentSource: http://www.nursefamilypartnership.org
National Examples of Early Childhood Development Best Practices
Harlem Children’s Zone • 97 block-area in Central Harlem, New York• Promise Academy Charter schools & 22 birth-to-college community
programs – Baby College, The Three Year Old Journey, Get Ready for Pre-K, Harlem
Gems• Significant outcomes:
– 100% of Harlem Gems school ready for 6 consecutive years– 97-100% of 3rd graders at-level in math & English language arts– 97% of 8th graders at-level in math
• vs 7% avg for Black 8th graders
– Closing Black-White achievement gap Source: Dobbie & Fryer, 2009
National Examples of Early Childhood Development Best Practices
A Lesson in North Karelia
• In the 1970’s, North Karelia, Finland was plagued by exceedingly high deaths from cardiovascular disease
• “It was a question of general lifestyle of the community - not just some people with high risk factors. The whole environment had to change - the food industry, restaurants, cafeterias, supermarkets.”
- Pekka Puska, Project Director
A Lesson in North Karelia
What they did:– Towns were pitted against each
other in cholesterol-lowering competitions.
– Food-labeling laws were changed – The national school-lunch program
got a major overhaul – They convinced bread companies
to use less salt and replace butter with vegetable oil
– They made sure walking paths were clear
– They passed laws to provide facilities for their citizens to get exercise
Results:– The smoking rate dropped
from 52% to 31%– Coronary heart disease
mortality fell by 73%– Lung cancer mortality
dropped by 71% – All-cancers mortality dropped
by 49%– Overall mortality declined 45%– 6 to 7 extra years of life
expectancy were added
Levels of Impact
Sustainability Institute, adapted from other versions from the organizational learning field
Philanthropic Collaborative for a Healthy Georgia
• Individual Providers
• Incentives for Collaboration
• Change the System/Policy/Environment
Opportunities for Leverage
Strategic AlignmentTriple-Layer Chess
Local
National
State
Visit www.gsu.edu/ghpc or follow us on Facebook for more information and
resources.